Houston Plastic Surgery Clinic Cosmetic Surgeons of Houston Plastic Surgery Houston plastic surgery and Houston plastic surgeon in Texas providing liposuction breast augmentation enlargement and facelift or face-lift cosmetic surgery by Board Certified cosmetic surgeons. Houston Texas plastic surgeon providing liposuction breast augmentation enlargement and facelift cosmetic surgery Board Certified.

METHODS

Between March of 1994 and June of 1996, 1 performed 90 consecutive micrograft and minigraft megasessions. All patients were carefully selected with good supplies of donor hair and realistic expectations. Postoperatively, they were followed closely to evaluate potential complications such as infection, hematoma. dehiscence of donor site, deforming scars, inclusion cysts or ingrown hairs, and absent hair growth.

The majority of the patients were Caucasians; however, there were some Hispanic, Mediterranean, Indian, Pakistan, Oriental, and black American patients. For evaluation of patient satisfaction, only 85 patients were considered, because two were lost to follow-up and three were less than 6 months postoperative. The 85 patients were personally interviewed by my office staff regarding their level of satisfaction.

TECHNIQUE

All procedures were performed in an office surgical suite setting under intravenous sedation with the use of Versed (Midazolam), Sublimaze, and local anesthesia. Vital signs, oxygen, and electrocardiogram readings were monitored throughout the procedures.

The sedation was used in most cases only to administer painlessly the local anesthetic; then, the patient was allowed to be awake for the majority of the surgical time. A total of 30 to 40 ml of 0.5% Marcaine (Bupivacaine) with epinephrine (1:200,000) was used to block the occipital and supraorbital nerves and to provide ample subcutaneous infiltration to the donor site and the upper forehead. This allowed for total numbness for the duration of the procedure.

In addition, a total of approximately 160 ml of 0.25% Xilocaine with epinephrine (1: 200,000) was used throughout each case for tumescent infiltration. Our four-person surgical team consisted of two cutting grafts and one assisting the author in inserting the grafts. (I personally inserted every graft.) With the patient in the supine position, a horizontal occipital ellipse 15 to 25 cm long by 1.5 to 2.5 cm wide was harvested; the size depended on the number of grafts to be made and the density of the donor site. The patient's head was turned to the left, allowing for a comfortable harvest of the right half of the ellipse, which was immediately handed to my assistants for cutting it into micrografts and minigrafts (Figs. I through 6).


FIG.1. Harvesting the right half of the occipital donor ellipse (patient in supine Position)	Fig.2. Donor site closed. After this, the left half is harvested.	Fig.3. Processing the donor horizontal ellipse into thin slices (2 mm).

FIG.4. Further dissection into actual micrografts and minigrafts.	FIG.5. Close up appearance of the micrografts and minigrafts.	FIG.6. Approximately 1100 micrografts and minigrafts are seen here ready for insertion .

FIG.7. Micrograft insertion into slits. I start in the front and go posteriorly.

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